Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms

1975 ◽  
Vol 43 (3) ◽  
pp. 255-274 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Collateral Flow ◽  
Patient Death ◽  
Artery Ligation ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
Complete Thrombosis ◽  
Fine Print

✓ The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

Successful surgical treatment of giant aneurysm of the basilar artery

1978 ◽  
Vol 49 (1) ◽  
pp. 124-128 ◽  
Author(s):  
Chhabi Bhushan ◽  
Fred J. Hodges ◽  
John Posey
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Giant Aneurysm ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors describe a case of giant aneurysm of the basilar artery successfully treated by bilateral vertebral artery ligation at the sulcus arteriosus of the atlas.

Posttraumatic bilateral vertebral artery occlusion

1981 ◽  
Vol 54 (6) ◽  
pp. 814-817 ◽  
Author(s):  
Eric G. Six ◽  
W. Lynn Stringer ◽  
A. Ron Cowley ◽  
Courtland H. Davis
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Posterior Fixation ◽  
Kirschner Wires ◽  
Content Type ◽  
Vertebral Arteries ◽  
Vertebral Artery Occlusion ◽  
Neurologically Normal ◽  
Collateral Vessels ◽  
Fine Print

✓ A case of bilateral vertebral artery occlusion following trauma in a 25-year-old woman is presented. The patient had minimal subluxation of C-2 on C-3 without neurological deficit. Her neck was immobilized for 16 days, and then a posterior fixation of C-1 through C-4 was performed with Kirschner wires and methyl methacrylate. Occlusion of the vertebral arteries has persisted, but collateral vessels are adequate and the patient has remained neurologically normal.

Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

1993 ◽  
Vol 78 (2) ◽  
pp. 192-198 ◽  
Author(s):  
Randall T. Higashida ◽  
Fong Y. Tsai ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Tony Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Cerebral Circulation ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Atherosclerotic Stenosis ◽  
Basilar Arteries ◽  
Posterior Cerebral Circulation ◽  
Fine Print

✓ Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1 %) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 161-173 ◽  
Author(s):  
Gary K. Steinberg ◽  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Clinical Outcome ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Intracranial Aneurysms ◽  
Artery Occlusion ◽  
Neurological Deterioration ◽  
Content Type ◽  
Vertebrobasilar Junction ◽  
Aneurysm Thrombosis ◽  
Fine Print

✓ Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

Abstract 1122‐000027: Bilateral Vertebral Artery Occlusion and Involvement of the Posterior Circulation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Brian A Tong ◽  
Dan‐Victor Giurgiutiu
Keyword(s):  
Vertebral Artery ◽  
Collateral Circulation ◽  
Lumbar Fusion ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Collateral Flow ◽  
Total Occlusion ◽  
Mortality And Morbidity ◽  
Vertebral Artery Occlusion ◽  
History Of

Introduction : Rationale: Bilateral vertebral artery occlusion with collateral reconstitution is a rare finding. Compared to patients with acute occlusion, symptom progression may be much slower [1]. Atherosclerotic risk factors lead to occlusion, including hypertension and hyperlipidemia, but it is unclear what leads to collateral reconstitution [2]. These patients may have collateral circulation from anterior and posterior circulation sources that are well developed [1] [2]. Sufficient collateral flow correlates with lower rates of hemorrhagic transformation following recanalization [3] [4]. However, given the risk of spontaneous hemorrhage from microvascular collaterals, the hemorrhagic risk associated with thrombolytic therapy in patients with moyamoya collaterals, due to the fragility of these vessels [5], must be balanced with the benefit of therapy in the presence of severe neurologic deficits along with the mortality and morbidity that may stem from the occlusion. Patient concerns: 67 year old Caucasian male with past medical history of coronary artery disease, abdominal aortic aneurysm, hypertension, history of tobacco use and type 2 diabetes mellitus presents with acute right‐sided weakness. Methods : Diagnoses: On admission, CTA Head and Neck suggested chronic total occlusion of bilateral V4 segments from their origin to the midportion with tandem bilateral high‐grade stenoses throughout the imaged distal V2 and V3 segments bilaterally. MRI could not be obtained because of old lumbar fusion spinal hardware. Cerebral angiography showed microvascular reconstitution, analogous to moyamoya, with slow mid basilar flow, which could be either due to occlusion or competitive flow from top of the basilar collaterals. Interventions: Patient received intra‐arterial integrilin and tPA thrombolysis with TICI 1 reperfusion. Results : Outcomes: Patient presented with NIHSS 18 notable for right sided weakness (2/5 strength in his right upper extremity and 1/5 strength in RLE), bilateral hemianopia, severe dysarthria and right gaze preference. Patient had significant improvement in his exam the next day following thrombolysis. Notably, patient had 5/5 strength in his right upper and right lower extremities compared to his strength on presentation. Repeat head CT on the following day after thrombolysis showed left pontine infarct. Repeat NIHSS was 3 at 24 hours for partial hemianopia, minor nasolabial flattening and mild dysarthria. Conclusions : Conclusion: Bilateral intracranial vertebral artery stenosis and occlusion commonly occurs distal to PICA and near the vertebrobasilar junction [2]. Proximal (specifically areas supplied by PICA) and distal territories within the posterior circulation are often infarcted [2], which can yield a unique exam upon presentation that can help accurately guide diagnosis and treatment when appropriately recognized. The involvement of collateral circulation can play a crucial role in patients undergoing endovascular revascularization therapy [6]. In the setting of bilateral vertebral occlusion with microvascular reconstitution, patients can still undergo catheter based thrombolysis, but not thrombectomy.

Microvascular anatomy of foramen caecum medullae oblongatae

1991 ◽  
Vol 75 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Asim Mahmood ◽  
Manuel Dujovny ◽  
Maximo Torche ◽  
Ljubisa Dragovic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Outer Diameter ◽  
Vertebrobasilar Insufficiency ◽  
High Concentration ◽  
Content Type ◽  
Fine Print

✓ The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (± standard deviation) of 14.35 ± 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 ± 0.006 mm while that of trunks was 0.35 ± 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.

Intracranial vascular anastomosis using the microanastomotic system

1998 ◽  
Vol 89 (4) ◽  
pp. 676-681 ◽  
Author(s):  
David W. Newell ◽  
Andrew T. Dailey ◽  
Stephen L. Skirboll
Keyword(s):  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Content Type ◽  
History Of ◽  
End To End ◽  
Fine Print

✓ The authors describe the use of a microanastomotic device to perform intracranial end-to-end vascular anastomoses. Direct end-to-end anastomosis was performed between the superficial temporal artery and branches of the middle cerebral artery (MCA) in three patients. Two patients had moyamoya disease, with severe proximal MCA disease, and one suffered an internal carotid artery occlusion with poor collateral flow. All patients reported a history of recent ischemic symptoms. Each anastomosis was accomplished in less than 15 minutes with technically satisfactory results. Postoperative angiographic studies demonstrated patency of the bypasses in all patients.

Surgical reconstruction of the proximal vertebral artery

1984 ◽  
Vol 61 (5) ◽  
pp. 874-881 ◽  
Author(s):  
Fernando G. Diaz ◽  
James I. Ausman ◽  
Raul A. de los Reyes ◽  
Jeffrey Pearce ◽  
Carl Shrontz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Antiplatelet Agents ◽  
Artery Stenosis ◽  
Surgical Reconstruction ◽  
Vertebrobasilar Insufficiency ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial wound infection (one case). There were no deaths. Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.

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